A MERS-CoV outbreak is currently ongoing in a hospital in Riyadh city,
Riyadh region. The index case for this outbreak is the 49 year-old
female reported to WHO on 15 June (see DON posted 19 June, case no.1).
The case has co-morbidities. On 10 June she was admitted to the hospital
with unrelated symptoms.

She was triaged in the Emergency Department
for her illness. She was then admitted to the vascular surgery ward –
MERS-CoV infection was not considered. She was not isolated and was
managed in a multi-bed room. During this time, more than 49 HCWs and
patients were exposed.
After she was confirmed as a MERS-CoV case, a Rapid Response Team was
dispatched and extensive contract tracing was initiated. Twenty (20) of
those screened so far at the hospital and in the household have tested
positive for MERS-CoV. These are seventeen (17) healthcare contacts and
three (3) household contacts. Eighteen (18) of the twenty (20) are
asymptomatic.
The vascular surgery ward was closed and elective procedure were
reschedules. The necessary control measures are being put in place. Details of the cases

A 55-year-old, national,
female living in Riyadh city, Riyadh region. On 10 June she was admitted
to the hospital where the MERS-CoV outbreak is currently ongoing for an
unrelated condition. She is asymptomatic and was identified through
contact tracing of healthcare contacts. The patient, who has
co-morbidities, tested positive for MERS-CoV on 18 June. Investigation
is ongoing to find a possible link with the other cases detected in the
same hospital. The case has no history of exposure to the other known
risk factors in the 14 days prior to detection. Currently she is in
stable condition isolated in a negative pressure isolation room on a
ward.

A 64-year-old, national, female living in Riyadh city, Riyadh
region. On 19 May she was admitted to the hospital where the MERS
outbreak is currently ongoing for an unrelated condition. She is
asymptomatic and was identified through contact tracing of healthcare
contacts. The patient, who has co-morbidities, tested positive for
MERS-CoV on 18 June. Investigation is ongoing to find a possible link
with the other cases detected in the same hospital. The case has no
history of exposure to the other known risk factors in the 14 days prior
to detection. Currently she is in stable condition isolated in a
negative pressure isolation room on a ward.

A 28-year-old, non-national, female, working as healthcare worker in
the hospital where the MERS-CoV outbreak is currently occurring and
living in Riyadh city, Riyadh region. She is asymptomatic and was
identified through the contact tracing of healthcare contacts. The
patient, who has a history of caring for the index case, tested positive
for MERS-CoV on 18 June. The case has no history of exposure to the
other known risk factors in the 14 days prior to detection. Currently
she is in stable condition in home isolation.

A 38-year-old, non-national, female working as healthcare worker in
the hospital where the MERS-CoV outbreak is currently occurring and
living in Riyadh city, Riyadh region. She is asymptomatic and was
identified through the contact tracing of healthcare contacts. The
patient, who has a history of caring for the index case, tested positive
for MERS-CoV on 18 June. The case has no history of exposure to the
other known risk factors in the 14 days prior to detection. Currently
she is in stable condition in home isolation.

A 47-year-old, non-national, female working as healthcare worker in
the hospital where the MERS-CoV outbreak is currently occurring and
living in Riyadh city, Riyadh region. She is asymptomatic and was
identified through the contact tracing of healthcare contacts. The
patient, who has a history of caring for the index case, tested positive
for MERS-CoV on 18 June. The case has no history of exposure to the
other known risk factors in the 14 days prior to detection. Currently
she is in stable condition in home isolation.

An 82-year-old, national, male living in Najran city, Najran region.
He developed symptoms on 14 June and was admitted to hospital in Riyadh
on 17 June (not the hospital where the outbreak is currently on-going
in Riyadh). The patient, who has co-morbidities, tested positive for
MERS-CoV on 18 June. Investigation of history of exposure to the known
risk factors in the 14 days prior to the onset of symptoms is ongoing.
Currently the patient is in critical condition admitted to the ICU on
mechanical ventilation.

A 48-year-old, national, male living in Taif city, Taif region. He
developed symptoms on 11 June and was admitted to hospital in Taif on 15
June. The patient, who has co-morbidities, tested positive for MERS-CoV
on 16 June. He has a history of frequent consumption of raw camel milk.
He has no history of exposure to the other known risk factors in the 14
days prior to the onset of symptoms. Currently the patient is in stable
condition admitted to a negative pressure isolation room on a ward. The
Ministry of Agriculture was informed and investigation of camels is
also ongoing.

A 77-year-old, national, male living in Riyadh city, Riyadh region.
The case, who tested positive for MERS-CoV on 16 June, was admitted to
the hospital where the MERS outbreak is currently occurring. The case is
asymptomatic and has been identified through the contact tracing of
healthcare contacts. Investigation of epidemiological link with the MERS
cases detected in the same hospital is ongoing. The case has no history
of exposure to the other known risk factors in the 14 days prior to
detection. Currently the case is in stable condition in home isolation.

A 61-year-old, national, female living in Riyadh city, Riyadh
region. On 12 June, she was admitted to the hospital where the MERS-CoV
outbreak is currently occurring, for unrelated medical conditions. The
case is asymptomatic and was identified through contact tracing of
healthcare contacts. She tested positive for MERS-CoV on 16 June.
Investigation of epidemiological link with the MERS cases detected in
the same hospital is ongoing. The case has no history of exposure to the
other known risk factors in the 14 days prior to the detection.
Currently she is in stable condition in home isolation.

A 51-year-old, national, female living in Riyadh city, Riyadh
region. She was admitted to the hospital where the MERS outbreak is
currently occurring and was discharged from hospital on 15 June. She is
asymptomatic and was identified through the contact tracing of
healthcare contacts. She tested positive for MERS-CoV on 16 June.
Investigation of epidemiological link with the MERS cases detected in
the same hospital is ongoing. The case has no history of exposure to the
other known risk factors in the 14 days prior to the detection.
Currently she is in stable condition in home isolation.

A 69-year-old, national, female living in Riyadh city, Riyadh
region. On 24 February, she was admitted to the hospital where the
MERS-CoV outbreak is currently occurring, for unrelated medical
conditions. On 14 June, while hospitalized, she developed symptoms and
tested positive for MERS-CoV on 16 June. Investigation of a possible
link with the MERS cases detected in the same hospital is ongoing. The
case has no history of exposure to the other known risk factors in the
14 days prior to the onset of symptoms. Currently, the patient is in
stable condition admitted to a negative pressure isolation room on a
ward.

A 51-year-old, non-national, male who works as healthcare worker in
the hospital where the MERS outbreak is currently occurring and living
in Riyadh city, Riyadh Region. The case is asymptomatic and was
identified through the contact tracing of health contacts of the index
case. She tested positive for MERS-CoV on 17 June. The case has no
history of exposure to the other known risk factors in the 14 days prior
to the detection. Currently she is asymptomatic in home isolation.

A 33-year-old, non-national, female, who works as healthcare worker
in the hospital where the MERS outbreak is currently occurring and
living in Riyadh city, Riyadh Region. The case is asymptomatic and was
identified through contact tracing of contacts of the index case. She
tested positive for MERS-CoV on 17 June. The case has no history of
exposure to the other known risk factors in the 14 days prior to the
detection. Currently she is asymptomatic in home isolation.

A 59-year-old, non-national, female, who works as healthcare worker
in the hospital where the MERS outbreak is currently occurring and
living in Riyadh city, Riyadh Region. The case is asymptomatic and was
identified through contact tracing of contacts of the index case. She
tested positive for MERS-CoV on 17 June. The case has no history of
exposure to the other known risk factors in the 14 days prior to the
detection. Currently she is asymptomatic in home isolation.

A 35-year-old, non-national, female, who works as healthcare worker
in the hospital where the MERS outbreak is currently occurring and
living in Riyadh city, Riyadh Region. The case is asymptomatic and was
identified through contact tracing of contacts of the index case. She
tested positive for MERS-CoV on 17 June. The case has no history of
exposure to the other known risk factors in the 14 days prior to the
detection. Currently she is asymptomatic in home isolation.

A 36-year-old, non-national, female, who works as healthcare worker
in the hospital where the MERS outbreak is currently occurring and
living in Riyadh city, Riyadh Region. The case is asymptomatic and was
identified through contact tracing of contacts of the index case. She
tested positive for MERS-CoV on 17 June. The case has no history of
exposure to the other known risk factors in the 14 days prior to the
detection. Currently she is asymptomatic in home isolation.

A 30-year-old, non-national, female, who works as healthcare worker
in the hospital where the MERS outbreak is currently occurring and
living in Riyadh city, Riyadh Region. The case is asymptomatic and was
identified through contact tracing of contacts of the index case. She
tested positive for MERS-CoV on 17 June. The case has no history of
exposure to the other known risk factors in the 14 days prior to the
detection. Currently she is asymptomatic in home isolation.

A 58-year-old, national, male living in Riyadh city, Riyadh region.
He is asymptomatic and was identified through the contact tracing of
household contacts of the index case. The case tested positive for
MERS-CoV on 16 June. The case has no history of exposure to the other
known risk factors in the 14 days prior to the detection. Currently he
is asymptomatic in home isolation.

A 20-year-old, non-national, female living in Riyadh city, Riyadh
region. She is asymptomatic and was identified through the tracing of
household contacts of the index case. The case tested positive for
MERS-CoV on 16 June. The case has no history of exposure to the other
known risk factors in the 14 days prior to the detection. Currently she
is asymptomatic in home isolation.

A 31-year-old, national, female living in Riyadh city, Riyadh
region. She is asymptomatic and was identified through the contact
tracing of household contacts of the index case. She tested positive for
MERS-CoV on 16 June. The case has no history of exposure to the other
known risk factors in the 14 days prior to the detection. Currently she
is asymptomatic in home isolation.

A 57-year-old, non-national, female, who works as healthcare worker
in the hospital where the MERS outbreak is currently occurring and
living in Riyadh city, Riyadh region. The case is asymptomatic and was
identified through contact tracing of contacts of the index case. She
tested positive for MERS-CoV on 16 June. The case has no history of
exposure to the other known risk factors in the 14 days prior to the
detection. Currently she is asymptomatic in home isolation.

A 55-year-old, non-national, female, who works as healthcare worker
in the hospital where the MERS outbreak is currently occurring and
living in Riyadh city, Riyadh Region. The case is asymptomatic and was
identified through contact tracing of contacts of the index case. She
tested positive for MERS-CoV on 16 June. The case has no history of
exposure to the other known risk factors in the 14 days prior to the
detection. Currently she is asymptomatic in home isolation.

Contact tracing of household and healthcare contacts is ongoing for these cases.
Globally, since September 2012, WHO has been notified of 1,761
laboratory-confirmed cases of infection with MERS-CoV, including at
least 629 related deaths.